By Christian Regalado
Last month was the beginning of the Annual Enrollment Period (AEP). Those on Medicare Advantage plans and Prescription drug plans could make a change for 2025. Most plans changed usually with a reduction of dental benefits (this is the surprise). Normally most people just allowed their Advantage Plans to automatically renew, this year, they searched for a better plan.
The reason for changes was due to the Inflation Protection Act which required insurance companies to reduce their out-of-pocket maximum for Medicare drugs from $8000 to $2000. The “Hole in the Donut” also went away which was a period where the cost of drugs went up until you went into the catastrophic phase.
This change is wonderful news for those on expensive drugs. About 10% of Medicare recipients will qualify. I had a client come in and after I listed all her prescriptions, it showed that the cost was over $4000 per month. Under the new rule, she will be capped at $2000, and she can request a payment plan from her insurance carrier and spread the cost over the year paying $167 per month. That is the good news.
Because the insurance carriers will be absorbing the balance of these costs, they have spread them to the other 90%. This is being done by increasing costs of PDPs or prescription drug plans and making changes to formularies and drug deductibles. In many cases, those with stand-alone drug plans have seen their premiums double. I’ve also found many name-brand drugs have been removed from formularies and have been replaced by generics. That is the bad news.
For those on Advantage plans that include prescription drugs, the costs can be absorbed by reducing benefits such as dental. Other benefits have also been deleted or reduced. This will vary from carrier to carrier and plan to plan but all insurance companies had to make adjustments.
One bright spot is a focus on Part B Rebate plans. Most Advantage carriers offer them and for those that don’t use medical benefits very often, you can find a plan that will make payments toward your Social Security Part B premium. Some rebates are as low as $5 and others are over $150 per month.
After looking at alternative plans, most folks will stay where they are if their plan is working for them. Others that really want a stronger drug or dental benefit may move to a plan that offers better benefits.
If for some reason you don’t make a change by the December 7 deadline, you can make one change from January to March which is the Open Enrollment Period.
Lastly, you have probably seen the many Medicare advertisements pitched by famous folks. Be careful! They will try to collect your personal information which is sold to other telemarketers.
My recommendation is to deal with a reputable broker that won’t disappear after the sale and who will continue to work on your behalf.
Please remember that our services are free, and we can do consultations over the phone or at your home, but I also welcome clients to visit my office in Santa Rosa Beach. I am certified with many different insurance carriers, and I am happy to answer your questions and assist any way I can.
Email me at christian@evergreenhealthins.com or call (850) 687-7606.
Author: Sowal Editor
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